[ Question ]

COVID-19 transmission: Are we overemphasizing touching rather than breathing?

by steve21521 min read23rd Mar 202010 comments




Here's the CDC (yeah I know, not always a reliable source, but the Chinese government guide seems to back it up):

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).
  • Through respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.


It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Wait, what?? This is wildly at odds with the anti-transmission messaging I've heard. Where I live (USA), I hear endless appeals to wash hands, not shake hands, and not touch your face, etc. I hear barely a whisper about the grave risks of being indoors in a public, poorly-ventilated space. I mean, that CDC page seems to imply that standing in a poorly-ventilated grocery store, even >6 feet from others, may well be riskier than touching a point-of-sale touchscreen and then immediately touching your face. (Remember, the virus stays in the air 30 minutes. [ETA: oops, I just learned that that article was later retracted without explanation.] Or as another example, the implication seems to be that just breathing inside an empty elevator (which was previously occupied within the previous 30 minutes) is quite possibly an even higher-risk activity than licking the elevator buttons. Really? Really???

(And don't get me started on masks ... Masks & googles are not only not suggested in the USA, they're actively stigmatized, despite makeshift homemade masks being I think at least somewhat effective and not contributing to the ongoing supply shortage, and goggles not being in short supply at all....)

I'm posing this as a question because I don't have enough confidence, without doing more research, to declare that our public health messaging has been so wildly misdirected (at least, the messaging I've received). Does anyone have better evidence? Or what's your take?

(Update: After reading this article and this article, I'm somewhat less concerned about air that was exhaled more than a few seconds ago, and now thinking that the main things to think about are (1) being near someone coughing, (2) being near someone talking, (3) touching surfaces then touching your face, (4) aerosols from a bathroom (apparently a SARS patient with diarrhea was a super-spreader, infecting people up to 200 meters away!). I'm very uncertain about the relative importance of these four things. I'm also not sure what "near" means, see discussion here.)



New Answer
Ask Related Question
New Comment

3 Answers

Your Update suggests you've realized this by now, but your confusion seems to be stemming from not understanding the difference between _droplets_ (large particles, fall to ground within seconds) and _aerosols_ (small particles, can float for 10s of minutes). The reason why there is an emphasis on staying 6 feet away and being careful of touching contaminated surfaces, but not an emphasis on ventilation, is because it is thought that SARS-CoV2 is mostly expelled as droplets and not as aerosols. The purported contraction disappears in this light.

Droplets are larger particles that fall to the ground within seconds, but can be expelled up to ~6 ft / 2 meters by coughing and sneezing. Droplets can also be expelled by talking. Droplets containing the virus can directly land in the face of another person, hence the recommendations to stay 6 ft away. They can also land on surfaces, whence these surfaces become "fomites" that can pass the virus to other people via touching.

Aerosols are smaller particles that can remain in the air for longer periods and potentially be moved around by ventilation systems. I think aerosolized virus can in principle be expelled by an infected person but based on the reporting and scientist interviews I've heard (admittedly mostly on This Week in Virology), my understanding is that experts think that SARS-CoV2 is mostly being expelled and hence spread by droplets and not aerosols. Aerosolization might be more important in some situations, such as by certain types of high energy toilets acting on fecally shed virus, but perhaps more important when patients are intubated in hospitals to go on ventilators. And aerosolized virus might turn out to be more common and play a more important role in SARS-CoV2 transmission than experts currently think and so it's perhaps still something to be aware of as an individual and no doubt warrants more research.

Regarding how long aerosols remain in the air...I am not familiar with the retracted article you mentioned, but the NYT reported that the authors of the now famous aerosol + surface stability study said that aerosols of SARS-CoV2 stayed in the air for 1/2 an hour. The paper itself doesn't contain this 1/2 hour number, and the authors needed to use a rotating drum to keep the virus floating for 3 hours. My understanding is that the 1/2 hour floating time has nothing to do with SARS-CoV2 itself and is just a property of physics and the size of the particles. Which is still a long time. But the question is whether significant aerosolized virus is being produced by infected people in normal circumstances. In the above paper, the authors used a nebulizer to aerosolize live virus, it didn't happen naturally.

Note: I have not reviewed the scientific evidence that the CDC and other experts have used to draw the conclusion that droplets and contaminated surfaces are more important than aerosols for SARS-CoV2 transmission.

Where I live (USA, Kentucky), we've been under something much like "shelter in place" without the scary name and been engaged in social distancing, event cancellation, bars and restaurants closed, non-life sustaining businesses closed, strongly encouraged work from home, etc., etc. for over a week now. Masks & googles are being strongly encouraged in Kentucky to be crafted, sourced and donated for front-line healthcare and emergency workers plus at-risk populations. We're hearing massive messaging about the grave risks of being indoors in a public, poorly-ventilated space. Critical retailers like groceries and pharmacies are closing to sanitize then offering their first hour of being re-opened to at-risk populations, mostly the elderly, to reduce airborne transmission.

Are we in the same USA?

Are we overemphasizing touching rather than breathing?

I suspect that governments are favoring actionable advice over accuracy.

The west in general ran out of masks due to government incompetence and complacency, therefore they told us that masks don't work, because telling people that masks work but oops we don't have any would contribute to panic and discontent.

The virus spreads mostly through the air, but people can't easily stop that, so they emphasize hand-washing because it is actionable and gives people something to do and thereby reduces their anxiety. It is probably also slightly helpful - people already don't wash their hands enough and a bit more hand-washing has a low cost.

It's happened before. In WWII, they told people to collect various materials for the war effort, at least some of which were totally useless.